Literature of medicine: the era of fiction?

Here's a confession. When I was asked to judge the Wellcome Trust Book Prize, I knew precisely what kind of book would sway me even before I began my trawl through dozens of works of fiction and - mostly - non-fiction on the theme of health, illness or medicine.

Non-fiction had to be the winner. After all, the £25,000 prize was scooped up last year by Rebecca Skloot for her highly acclaimed The Immortal Life of Henrietta Lacks, which examined the life of Henrietta Lacks and how her death gave the world the immortal cell line known as HeLa.

Besides, I have only written non-fiction books (my two attempts at fiction - one book, one script - ended in failure). And the biographies, memoirs, history and pop science submitted for the BBC's Samuel Johnson non-fiction book prize, which I helped judge last year, had really impressed me. Indeed, in the wake of the horrors of 9/11, the likes of Ian McEwan and V. S. Naipaul have argued that non-fiction is better at capturing the complexities of today's world.

The novel is dead - long live non-fiction!

Yet in the wake of my efforts to judge the Wellcome prize, a gruelling process that has taken many months, we have ended up with a shortlist carrying only one example of straightforward non-fiction, along with one autobiography and four novels.

That is not to say non-fiction is dead. The one representative, The Emperor of all Maladies: A Biography of Cancer is a truly magnificent tome. Siddhartha Mukherjee, doctor, researcher and award-winning science writer, has written a lucid and eloquent page-turner, a biography of a disease that ranges from the Persian Queen Atossa, whose Greek slave cut off her malignant breast, to Carla, one of Mukherjee's own leukaemia patients.

His epic reminds me that truth can be stranger, more interesting and compelling than fiction. And that long-form narrative reporting can blend the best of both worlds when they include key ingredients of good fiction - notably a strong sense of plot and three dimensional characters. You learn an awful lot too. I was familiar with much of the material in Emperor but Mukherjee gives a heady, panoramic view of our battle with a disease that provides a distorted and murderous version of our normal selves.

I was also smitten by The Two Kinds of Decay, a memoir by Sarah Manguso. This stark, unsentimental and unflinching account of her battle with a rare autoimmune disease is moving, harrowing and darkly funny too. Instead of a seamless narrative arc it's diced into brief chapters that are titled like poems, and there is a strong emphasis on language and her quest to describe and name things once unnamed and unknown, notably the subjective nature of pain, misery and suffering. Of all the shortlist, I found this entry the most original.

The well-worn device of the unreliable narrator is given a deft twist in Turn of Mind, the first novel by Alice LaPlante, who teaches writing at Stanford and San Francisco State Universities, and - I was gratified to see - has written four works of non-fiction. The narrator, retired hand surgeon Jennifer White is our most fallible of unreliable narrators, detailing the slow deterioration of her mind and also insights into the murder of her friend: but did she herself do it? And can LaPlante carry it off? Yes. She gives a grimly believable portrayal of a mind descending into Alzheimer's, with the narrative sliding from first person to third. Incredibly, LaPlante has done the impossible, turning a story of dementia into a thrilling read.

Ann Patchett's State of Wonder, has Hollywood film adaptation written all over it. Her novel is layered with philosophical and ethical dimensions, taking us down the Brazilian Rio Negro in pursuit of Annick Swenson, a maverick scientist who's developing a drug that could grant lifelong fertility to women. Patchett crafts an absorbing story of her pursuit into the heart of the South American darkness. Perhaps it is a kind of modern female take on Conrad's quest into the interior of colonial Africa, with secretive Swenson as Kurtz, the ivory trader who has 'gone native.' One sign of its power is that I still find myself thinking about the fate of one character, Easter, the deaf, native boy Swenson had nurtured as her own child.

Another story that might well make it to the screen, of the small kind, is My Dear I Wanted To Tell You by Louisa Young. My fellow judge, Tim Lott, who knows a thing or two about how to write great fiction, adored Young's story of how Riley Purefoy and Peter Locke fight in the trenches for their country, their lives and their sanity. For my part, I was particularly struck by the part where Young eventually gets around to the grippingly gory details of plastic surgery at the time of the First World War.

Final confession. I had never read anything by the great Philip Roth until I had to judge Nemesis, his story of a polio outbreak in the 'stifling heat of equatorial Newark' in 1944. Unlike Albert Camus' moral fable, The Plague (La Peste), which has the pestilential coastal city of Oran as a symbol for France under the jackboot of German occupation, Roth's epidemic did not seem to have a broader metaphorical significance. The central character is Bucky Cantor, an idealistic 23-year-old gym teacher who has been rejected by the military because of his poor vision. A carrier of the polio virus, he provides another variant of the unreliable narrator. With Cantor's struggles with his feelings towards his religion and patriotism, Roth has given us a moving and timeless fable of personal nemesis.

I had always thought that truth is stronger than fiction. The Wellcome prize has taught me that, given the current financial gloom and doom, we may need to take refuge in imagined worlds more than ever before.

The panel of judges - Joanna Bourke, Tim Lott and Erica Wagner, Roger Highfield and Vivienne Parry - will appear at the Times Cheltenham Literature Festival on Saturday 7 October to discuss deathbed scenes in literature.

Have you ever considered publishing an e-book or guest authoring on other websites? I have a blog based on the same information you discuss and would really like to have you share some stories/information. I know my visitors would value your work. If you are even remotely interested, feel free to shoot me an e mail.